ESC慢性心衰指南课件（PPT 52页）.ppt

Relationship between cardiac dysfunction, HF and HF rendered asymptomatic Diagnosis According to the Working Group in Heart Failure, Heart Failure is a syndrome where the diagnosis has the following essential components: A combination of: Symptoms, typically breathlessness or fatigue Cardiac dysfunction documented at rest The diagnosis is supported by: Response to treatment directed towards heart failure Establish diagnosis Assessments in all cases Necessary Supports Opposes History with symptoms +++ If absent Objective evidence +++ If absent Response to treatment ++ Tests for Diagnosis Test Necessary Supports Opposes Electrocardiogram ++ If normal Echocardiography +++ If normal Chest x-ray If congestion If normal Blood count If normal Blood chemistry If normal Additional Tests for Diagnosis Test Necessary Supports Opposes Exercise test If normal Natriuretic peptide If elevated If normal Cardiac cath. If normal Test to Exclude Alternatives Chest x-ray (Lung disease) Pulmonary function Blood chemistry (Renal and hepatic disease) Blood count (Anaemia) Exercise tolerance (if impaired) Electrocardiography A normal ECG suggests that the diagnosis of heart failure should be carefully reviewed. The predictive value of a normal ECG to exclude LV systolic dysfunction exceeds 90% Chest X-ray A high predictive value of X-ray findings is only achieved by interpreting them in the context of clinical findings and ECG anomalies. It is useful to detect cardiac enlargement and pulmonary congestion In chronic heart failure, increased cardiac size and pulmonary venous congestion are useful indicators of abnormal cardiac function with decreased ejection fraction and/or increased LV filling pressure However, cardiomegaly is frequently absent in acute heart failure and in cases with diastolic dysfunction Pulmonary function tests Measurements of lung function are of little value in diagnosing chronic heart failure. However, they are useful in excluding respiratory cause